A 70-year-old white female was admitted comatose to the emergency room
after complaining one hour earlier of dyspnea which was followed by her
passing out. She had been hypertensive and on medication for years. The
initial emergency room exam revealed an unresponsive female with Cheyne-Stokes
respiration, pinpoint but equal pupils and decerebrate rigidity. Vitals
were blood pressure 296/110, pulse 72, respiration 20, temperature 99. Eight
hours after admission, the patient appeared cyanotic with cold extremities
and shallow respiration. She died 30 minutes later. In addition to the primary
lesion, neuropathological examination revealed bilateral uncal herniation
and secondary brainstem hemorrhages. Diagnosis: intracerebal hemorrage
Diagnosis: intracerebal
hemorrage
Case 2.
A 71-year-old female suffered two massive subarachnoid hemorrhages within
two weeks and , while awaiting craniotomy, suffered a third one. She was
in a comatose state with small, unresponsive pupils. After 3 days of no
change in physical and mental status, supportive measures were discontinued
&;she died. Pathogenesis: ruptured saccular aneurysm
Pathogenesis: ruptured saccular
aneurysm
Case 3.
The patient was a 74-year-old white male with a history of hypertension
and seizure disorder. He had a past history (more than several months) of
right-sided hemiplegia, right facial weakness, and expressive aphasia. The
patient was admitted to the hospital after complaining of a headache and
left-sided paralysis, and then losing consciousness. He did not regain consciousness.
Pupils were midposition and fixed. He died the following day.
a. What type and location of lesion would be expected as the basis
of the past neurological signs?
(a) infarct in the left cerebral hemisphere including left lateral motor
cortex (pre-central gyrus) and Broca's area.
b. What type and location of lesion would be expected as the basis
of the recent neurological signs?
(b) hemorrhage in the right cerebral hemisphere.
c. Extensive atherosclerosis was observed in the CNS vasculature.
What role did that play in this patient's problems?
(c) Atherosclerosis probably contributed to the thrombosis causing the
infarct.
